syndrome type ciguatera
Le 22 févr. 08 à 19:00, Martin Loranger a écrit :
Article tiré de Emerg Med Clinics of North Am. août 2007
Scombroid
Background
Scombroid poisoning occurs after ingestion of fish that has
accumulated scombrotoxin secondary to spoilage. The fish associated
with this toxicity are dark fleshed, containing large amounts of the
amino acid histidine. Scombroid food poisoning develops when an
individual ingests improperly refrigerated fish in which bacteria
have converted histidine into histamine and histaminelike
substances. Pure histamine itself is not toxic when taken orally.
Therefore, scombroid is not solely caused by excess histamine
ingestion. There are other factors involved in toxicity, including
substances that facilitate histamine absorption and urocanic acid
that acts as a mast cell degranulator adding to the histamine-
related symptoms. Fish commonly implicated include those in the
Scombridae and Scomberesocidae families, such as tuna, mackerel, and
bonito. Nonscombroid fish, such as mahi-mahi, bluefish, anchovies,
sardines, swordfish, and escolar, have also caused this syndrome.
Clinical presentation
Patients who ingest scombroid present with signs and symptoms of a
histamine reaction: flushing, erythematous or urticarial rash,
headache, dizziness, crampy abdominal pain, nausea, vomiting,
diarrhea, shortness of breath, and wheezing. In severe cases it can
lead to hypotension and even hemodynamic collapse. The ingested
causative fish usually does not smell or taste spoiled, but the
victims often report an unusual peppery or metallic taste. Symptoms
begin within an hour and usually last less than 12 hours.
Scombroid poisoning may be worse in patients taking isoniazid.
Isoniazid acts as a histaminase inhibitor. Patients taking isoniazid
may have more severe or prolonged reaction to scombroid poisoning.
Diagnosis
The diagnosis is accomplished by observing the clinical syndrome of
scombroid toxicity with a history of eating causative fish. Although
the treatment of scombroid is similar to that of an acute type I
allergic reaction, it is important to not label these as allergic
reactions. These patients do not have seafood allergies and should
not be told to avoid seafood.
Evidence suggests that victims of scombroid poisoning have elevated
plasma and urinary histamine levels . This finding may aid in
confirming cases but is not useful in guiding emergency clinical
decisions. The fish may also be tested to aid in confirming the
diagnosis, but this can be misleading because histamine levels can
vary greatly even within the same cut of fish.
Management
The cornerstone of treatment is with antihistamines. Intravenous H1
and H2 blockers (ie, diphenhydramine and cimetidine, respectively)
should be administered. Bronchodilators (ie, albuterol) can be
helpful if the patient experiences bronchospasm. Severe cases, with
hypotension and respiratory distress, require aggressive treatment
with intravenous fluids, airway control, and possibly epinephrine.
Scombroid poisoning is a self-limited illness; symptoms typically
resolve within 12 hours.
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Subject: URG-L: Re: URG-L: Beau cas mystère!
Date: Fri, 22 Feb 2008 18:43:18 +0100
syndrome histaminique le marlin fait il partie de la famille
des scombridés ?
13 ans et deja une jeune femme, troublante adolescente
----- Original Message -----
From: Martin Loranger
To: [EMAIL PROTECTED]
Sent: Friday, February 22, 2008 6:22 PM
Subject: URG-L: Beau cas mystère!
Jeune femme de 13 ans, qui se présente après avoir mangé du marlin
bleu, et qui aurait eu des rougeurs sur le corps (urticaire?) et une
sensation de prurit dans la gorge et de sensation d'oppression
thoracique, quelques minutes après le début d'ingestion. Aucun
antécédent pertinent. Aucune allergie connue ni chez elle ni dans
la famille.
Je retourne voir la pte, vue par une excellente résidente, afin de
discuter de l'observation ou non avec la mère. Je note que la pte
mange du poisson très fréquemment, et que c'est la première fois
qu'une telle réaction a lieu, même si elle a déjà mangé du marlin
bleu auparavant. Je demande à la mère si au moins le poisson était
bon: "C'est drôle parce que tout le monde a eu une drôle de
sensation en bouche, comme si c'était trop épicé...". D'ailleurs,
la mère a eu elle aussi des rougeurs au visage et sur les bras,
ayant duré moins de temps... La mère m'assure ne pas avoir trop
épicé le poisson...
La jeune est maintenant ASx, 4 heures après l'ingestion. Signes
vitaux normaux actuellement et à l'arrivée, quelques heures plus tôt!
La mère lui a donné 50 mg de Bénadryl à la maison.
Votre Dx?
Martin Loranger
Urgence Charles LeMoyne
